Academic journal article Australian Health Review

The Challenges of Change Management in Aboriginal Community-Controlled Health Organisations. Are There Learnings for Cape York Health Reform?

Academic journal article Australian Health Review

The Challenges of Change Management in Aboriginal Community-Controlled Health Organisations. Are There Learnings for Cape York Health Reform?

Article excerpt


The health status of Aboriginal and Torres Strait Islander peoples continues to be significantly poorer than Australia's general population. Clearly there is a need for change, hence the renewed interest in transitioning to a community control model for health services as a health intervention. Yet this requires a significant change management process, which is a process developed using Western business philosophies, and may not be applicable for community-controlled services that need to operate within the Aboriginal cultural domain.

This paper examines the literature on organisational change management processes, and features of Aboriginal community-controlled health organisations and Aboriginal management styles. It identifies challenges and synergies that can be used to inform more effective transition processes to a community-control model for health services. The findings also highlight the need for a fundamental systems change approach to achieve such major reform agendas through the creation of a "collective responsibility" to achieve the vision for change, utilising participatory change management processes both internally and externally.

Aust Health Rev 2008: 32(4): 639-647

IT HAS OFTEN BEEN SAID that the surest way to fail in the long term is to continue doing what you have always done.1 The same can be said for efforts to improve health of Aboriginal people, as demonstrated by the health status of the Indigenous versus non-Indigenous populations. "Over the period 1999-2003, Indigenous males and females died at almost three times the rate of non-Indigenous males and females. Indigenous Australians also had higher rates of mortality from all major causes of death."2 (page 178)

The need to change the service model to address the discrepancies in health status has led to a renewed interest within Queensland Aboriginal and Torres Strait Islander communities in taking control of health service delivery where such services do not currently exist. It is well recognised that a sense of control over one's life has a positive influence on health and wellbeing.3 Conversely, a loss of control has a negative impact on health. Community-controlled health services are therefore not just an alternative service delivery model to mainstream health services, but rather a health intervention in their own right, given that "vastly better Aboriginal health outcomes are possible with community-controlled and managed primary health care."4 Since the establishment of the first Aboriginal Medical Service at Redfern in Sydney in 1971, Aboriginal community-controlled health services have been increasing throughout Australia. Their primary goal is to give back control over decisions associated with health outcomes to Indigenous communities across Australia in an effort to improve health.5

In Cape York, there are no community-controlled health services. Health services are delivered by mainstream service providers, primarily Queensland Health, the Royal Flying Doctor Service; the Far North Queensland Rural Division of General Practice; and various visiting specialist services. If significant improvements in the health status of Cape York communities are going to be achieved, control of health services must be given back to the communities.4

This has led to the Cape York Health Reform project that is being led by the Apunipima Cape York Health Council Aboriginal Corporation (Apunipima). A transition implementation plan has been developed to inform the organisational changes required for Apunipima to take on the role of a community-controlled health service for Cape York in the future.

However, this reform requires a significant change management process, as Apunipima shifts from an advocacy body to a primary health care provider. Yet organisational change management is based on business literature, which is primarily generated from the mainstream Western culture, whereas one of the strengths of Aboriginal community-controlled health services is their ability to manage and deliver health services within the Aboriginal cultural domain. …

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